10 strategies for_extraordinary_success_biz_med
Transcript of 10 strategies for_extraordinary_success_biz_med
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PRESENTED BY:
MedicalCodingCashSecrets.com
Let me cut to the chase.
The more effectively you code your medical encounters, the more money you will
make – period. I know this, not only because of the supporting data, but because
I’ve experienced this fact in my own medical practice.
In fact, a recent survey showed that more than 33% of visits involving established
patients are under-coded. What is worse is that physicians are failing to document
and code for issues unrelated to initial patient visits. The trends show that most
physicians are causing themselves to be underpaid for services they provide (as if
Medicare and insurance reimbursement cuts don’t make it hard enough).
Before I learned the key to generating outstanding revenues in my medical
practice, I was losing nearly $100,000 per year – just because I didn’t understand
how to use CPT codes the RIGHT way.
When you consider the constant reductions in our revenue stream as a result of
external factors, our ever increasing medical practice overhead, and the massive
resources allocated to handling paperwork requirements on a daily basis, it is not
difficult to see why our country is facing a severe shortage of healthcare providers.
The good news is that it does not have to be this way. You see, medical coding is
simply a process that involves assigning codes to the identification and treatments
of ailments, which dictate the level of financial reimbursement you may receive
from insurance companies and government agencies.
Unfortunately, this “simple process” is cumbersome and requires diligent
attention to the details of patient encounters if you want to receive the level of
reimbursement you deserve.
I can’t stress this enough: if you know how to properly apply CPT codes to your
diagnosis, you can make the process simple for yourself and make significantly
more money. Your success lies in having this knowledge.
INTRODUCTION
This is why I developed Medical Coding Cash Secrets – I wanted to share my
shortcut simplifying the process and maximizing revenues. The day I decided that I
would no longer be underpaid and overworked changed everything. So, I
encourage you to make the same decision for yourself.
These 10 essential strategies are the foundation upon which medical coding
success is built. If you implement these 10 essential strategies and then apply the
knowledge provided in Medical Coding Cash Secrets, I can assure you, you will be
amazed at the results.
Now, time for the 10 essentials.
If you learn to ethically code routine office visits and regular checkups
at the highest level payable for each patient you see, you will
automatically double your income. You may not believe it, but I can
assure you that you are doing this. In my consulting with physicians
one-on-one, I’ve discovered that there is a general misconception
related to the proper level coding of routine visits and regular
checkups. What you, the provider, must understand how to use
“medical decision” and “medical necessity” to determine which CPT
coding group adequately covers the office visit. If you make a point to
understand how to maximize your billing potential through the proper
usage of CPT codes, you will instantly enjoy the benefits of insurance
reimbursement at a higher level.
Not all insurance reimbursement contracts are the same, and you have
the right to negotiate the terms of your contracts. When the time
comes to renew your reimbursement contracts, review them carefully
and look for places where other carriers are providing more
competitive reimbursements. For example, you can point out where
other insurance companies reimburse for certain combinations of add-
on codes and request they match your other contract terms. Keep in
mind, many of these insurance companies are related corporately and
1. Learn to code at the highest level payable.
2. Aggressively review and negotiate your reimbursement contracts.
you can use this fact to your advantage is you find that one insurance
company related to another insurance company is trying to reimburse
differently. Under these circumstances, ask your contract
representative to explain the variance and adjust it accordingly.
As CPT and ICD codes become more specific, you need to be more
specific in the way you code individual encounters. For example, one
code for chest pain may be better suited as chest pain plus any of the
numerous associated symptoms that are related to it – this type of
evaluation will require its own individual codes that will provide you
with larger reimbursements.
Coding with specificity and precision is not just about maximizing your
reimbursements, but the right code with the right diagnosis is also
going to help you provide superior patient care while reducing your
denials and requests for medical records. Getting stuck resolving
denials and requests for medical records slows down your workflow
and cash flow as a result of delayed payments. Avoid this outcome by
coding procedures correctly the first time and you will get what you are
entitled to….your hard earned money.
Even though your patients may come in for a routine office visit, you
may be able to combine procedures for reimbursement - if you code
3. Learn to code with specificity and precision.
4. Take detailed chart notes.
them properly. Consider a situation where you routinely remove skin
lesions, moles, or tags. Instinctively, you will bill for the removals, but
what if your patient also needed prescription renewals for other health
issues? Or what if they discussed a new ailment while you conducted
the removals? Did you bill for these other matters? You should! Simply
add on a routine office visit code. To ensure that you will be paid for
both codes, document the incidents separately in the chart notes. From
there, simply add the appropriate modifier to the office visit and for
each lesion removal. It’s simple, appropriate, and an additional $15,000
in revenue each year if you do this across your patient panel.
Do you know why your insurance reimbursement claims go unpaid?
Finding out why claims are unpaid is a key component to capturing
revenue that is just waiting to be collected. There are numerous
reasons why claims do not get paid, and more often than not an input
error is to blame. For example, a claim may have been sent to the
wrong department due to an input error and is automatically denied.
This is a simple oversight that should be fixed and re-sent. Knowing why
the claim is denied is essential to getting paid when the claim is
resubmitted. Oftentimes, medical billers just resend the
reimbursement claim for a second and third time but never check to
see why the claim is not being paid. As such, your claim sits on your
aging report and you lose money because someone was too lazy to take
5. Create a system for following up with unpaid claims.
an extra step. You can prevent this by creating a system or using a
checklist for each denied claim so that they are paid upon
resubmission. Remember, there is a limited time to capture your
money from your reimbursement carrier so keep your aging reports up
to date and aggressively pursue denied claims.
Insurance companies love to give you the responsibility of educating
yourself on their reimbursement rates. It’s no coincidence that fee
schedules are rarely attached to your contract and must be “requested”
or “downloaded online.” Today it is not uncommon for insurance
companies to use Medicare as a reimbursement guide (this is where
everything has shifted to their advantage), so contracts often read
“reimbursements are at 90% or prevailing Medicare fee schedule,” or
similar language.
No matter how many times you’ve seen these contracts, always have
your healthcare attorney or someone who understands contracts
review the clauses in your reimbursement contract with you. And
always, always closely review the reimbursement schedule or fee
schedule for all CPT codes that you provide in your office. Make sure
these reimbursement rates are reasonable to you and your practice;
you have the right to refuse inadequate compensation. Do not get
6. Don’t sign a reimbursement contract without seeing the fee schedule first.
caught working harder for less money. Instead, work smarter for more
revenue.
As a doctor, your main focus is to provide excellent care to your
patients. Nevertheless, your practice must always obey the
fundamental laws of good business. Finance, marketing, and operations
are critical elements to your success. Regardless of whether you have a
medical billing and coding specialist in your office or one working on
your account a remote location, your practice will suffer if you do not
actively manage these areas of your practice. Remind yourself, you own
a medical practice AND a business.
“Medical necessity” is a somewhat nebulous concept and is described
in less detail than some of the other coding definitions. Despite this
fact, you must get familiar with the concept and develop a concrete
understanding of “medical necessity” to avoid the pitfalls of denied
claims and delays in payment. The Medicare Claims Processing Manual
says “medical necessity is the overarching criterion for payment in
addition to the individual requirements of a CPT code. It would not be
medically necessary or appropriate to bill a higher level of evaluation
and management service when a lower level of service is warranted.
7. You must think like a business owner, not just as a doctor.
8. Understand the concept of “medical necessity”.
The volume of documentation should not be the primary influence
upon which a specific level of service is billed. Documentation should
support the level of service reported.” This puts adequate
reimbursement on your shoulders. Are you fully documenting your
service? Do you know how to fully document for higher level
evaluations? You could be losing revenue daily because of it.
Many times, physicians encounter patients who bring up new problems
during the routine office visits. These new problems may range from a
slight headache the night before to a tiny lump on their forehead.
Sometimes patients reveal something more serious, for example,
symptoms indicating the earliest manifestations of osteoarthritis. In
these situations, most physicians fail to recognize the instant
justification for billing at a higher and more precise level.
As the only person able to assess the level of a patient encounter you
must become vigilant about identifying opportunities to increase the
billable level of an office visit. You a given the opportunity to increase
revenue daily.
I consistently see physicians fail to identify the shift from a “casual” low
complexity 99213 office visit to a moderate complexity 99214 office
visit. Don’t do this to yourself. You owe it to yourself to properly
9. Recognize the need to increase the billable level of an office visit.
document and code complexity with accuracy and maximize the
revenue you’re entitled to receive.
If you have unresolved claims 25 days or older, you’ve failed to
implement a system for denied claims. Claims 25 days or older should
be revisited on a monthly basis. This will help you identify claims that
may not have been received, as well as enable you to start the appeals
process on claims that have been denied. If you have a fairly large
practice, you may benefit by setting aside one day a month where
everyone on your staff works on claim follow-up projects.
Once you identify claims that need to be reprocessed, you should break
them down into categories of difficulty. As a general rule of thumb, you
will find that claims denied for coordination of benefit, or other patient
issues will be hardest to resolve. It can also be difficult to get patients
to comply with demands for additional information if you do not see
them on a regular basis. Under these circumstances, you should adopt
a billing policy that will enable you to send bills and correspondence to
the patient as reminders.
10. Don’t allow claims to go unresolved for more than 25 days.
I know that you will see great improvements in your medical practice by applying these 10 essential strategies, and it is my hope that you will do it. I have a passion for helping my colleagues succeed because I know what it is like to work so hard and see so little in return. Our privilege to help and serve others is incredibly rewarding, but sometimes it is not enough in light of all the obstacles we face on a daily basis.
I hope that you will be encouraged to learn more about Medical Coding Cash Secrets (and take advantage of our current special offer), because even though your clinical intuition and medical experience will guide you through the daily patient encounter, effective and strategic coding will dictate your level reimbursement.
REMEMBER: Your documentation and coding must reflect the intensity of service that you render! Once you learn to accurately code in the most detailed yet efficient way, you will begin to be highly paid for the work that you do. Unfortunately, this is not intuitive. Think about it; in the course of learning and practicing medicine, who took the time to teach and train us on the billing and coding of our medical claims? NO ONE!
You must take the time to develop this skill. Don’t you think earning an additional $100,000 per year is worth the time and minor investment?
I guarantee you that it is.
Best of luck to you and your future success,
Dr. Adam Alpers, DO
P.S. If you are ready to start learning the keys to coding and reimbursement success today, simply fill out the form below and fax it to: 352-368-6027 or visit medicalcodingcashsecrets.com today!
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